Healthcare Provider Details

I. General information

NPI: 1235171810
Provider Name (Legal Business Name): OP MIFFLIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 67 BOX 7
MIFFLIN PA
17058-9801
US

IV. Provider business mailing address

800 CONCOURSE PKWY S SUITE 200
MAITLAND FL
32751-6148
US

V. Phone/Fax

Practice location:
  • Phone: 717-436-8921
  • Fax: 717-436-9165
Mailing address:
  • Phone: 407-571-1550
  • Fax: 407-571-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number123402
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1012263640001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JOSEPH CONTE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-571-1550